20,000~ Medicaid Recipients: Homeless, January 1, 2013

Literally THOUSANDS of mentally disabled, NC Medicaid recipients may be on the streets of NC come January 1, 2013. Perdue claims that her last act as governor will be to prevent this to happen. But can she? No. Not alone.

Due to recently passed federal legislation, The Center for Medicare and Medicaid Services told North Carolina last year that personal care services (such as assistance with daily ADL‘s like eating, bathing, and toileting) must be reimbursed at the same rate for Medicaid patients who live in private homes and for those in group homes. It is estimated that the change in the reimbursement rate would cause $414 million less payments to group homes caring for Medicaid recipients suffering from mental illness. The result of this massive cut in Medicaid payments to group homes will cause most group homes in North Carolina to go bankrupt, resulting in all the Medicaid recipients residing at the group home to be put out on the street.

Group homes must abide by extremely stringent state and federal laws to keep their doors open. Therefore, group homes are exceedingly expensive to run. Not to mention that group homes must have 24-hour, 365 days/year employees. The cost to run a group home is staggeringly higher to run than a private home. It is illogical why the government would pay a private home and a commercial group home the same Medicaid rate. In a private home, the people live at the home; therefore private homes do not need to pay for numerous employees to work 24-hour, 365 days/year. Yet, due to federal legislation, Medicaid will reimburse group homes the same as private homes.

Can we stop this tomfoolery? It is up to the state legislators. While they relax for Christmas vacation, come New Year‘s approximately 20,000 adult Medicaid recipients may be on the street. While legislators sip hot toddies with a roof over their heads, 20,000 will be freezing in the middle of winter, homeless, during one of the coldest months of the year. Action is needed. State legislators have advised Perdue to fund these group homes will alternative funding. However, Perdue has stated this is impossible due to the language of statutes. What is needed? A special session! Make the legislators come back for a special session. If the legislators get to ring in the New Year with a roof over their heads, don’t the residents of North Carolina’s group homes deserve the same?

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Knicole C. Emanuel

Knicole C. Emanuel is an attorney at Potomac Law Group in Raleigh, NC where she concentrates on Medicare and Medicaid regulatory compliance litigation. See legal disclaimer @ "About Knicole."
Follow her on Twitter at @medicaidlawnc.